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Health Insurance for the Self-Employed? 462

Posted by Cliff from the an-issue-that-deserves-another-look dept.
SharkJumper writes "Looks like this question has been asked before, but might be due for an update. I'm a self-employed programmer who is about to become a father. Previously, my family's insurance has come through my wife's employer, but she is eagerly looking forward to being a stay-at-home mom. We must look for that elusive low-cost insurance in order to enable her to do this. Losing her insurance is not a huge loss as, due to failed negotiations, the hospital in our city (3rd largest city in the state), along with most of the doctors that refer to it, is dumping the network (largest in the state) that our insurance uses. On the individual coverage plan front, my research shows story after story of deception, fraud, and general run-around or obfuscation by most of the major players and nearly all the minors. With all of the bad experiences out there, I've yet to see a good review of an insurance company. What does the Slashdot crowd use and recommend? Company and plan-type? PPO? HMO? HDHP + HSA (High Deductible Health Plan + Health Savings Account)?"
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Health Insurance for the Self-Employed? More

Health Insurance for the Self-Employed?

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  • But you'll need a plan that has a low co-pay for doctor visits since you will take your kid just about all the time for everything from his/her first sniffles (OMIGOD TB!) to fevers (OMIGOD FLU!) to standard vaccinations (OMIGOD YOU'RE GOING TO STICK HIM WITH A NEEDLE!). The cumulative costs of a high co-pay is going to eclipse the savings you'd see with that sort of plan. The higher-cost low co-pay plan pays off in the long run with kids.

    For yourself you probably can get by with catastrophic coverage unles

    • Re: (Score:3, Interesting)

      by Ihlosi ( 895663 )
      Instead of great health coverage for you, get LIFE INSURANCE. You can probably get some cheap 30-year term insurance which will cover your family in case something happens to you.

      Don't forget some sort of disability/invalidity insurance (don't know if they've got that thing on your side of the pond, it's the big thing over here in Yurrop). If you can't get that (pre-existing medical conditions and certain professional fields are a factor here), go with accident insurance.

      For all the things that don't k

    • And if there is, you're just about out of luck anyway since many carriers won't cover existing conditions.

      Many companies only exclude pre-existing conditions if you are without insurance for 30 days or more before signing up with them. If you keep continuous coverage, you're fine.

      Of course, that doesn't mean they have to agree to cover you at all if you have a pre-existing condition, but that's another story.

      I agree that the wife should have good coverage at least for a while yet, and a comprehensive

  • Small business associations (Score:4, Informative)

    by oneiros27 ( 46144 ) on Friday December 01, 2006 @07:15AM (#17063364) Homepage
    A while back, on the radio (WTOP in the Washington, DC area), they played an advertisement for a small business association, or something like that. One of the benefits of joining was that they had offered a group health plan to the member companies.

    I don't know for sure if it was specifically a small business association, or that's what I just remember it as, or if it was a local or national thing, but you can try asking around. (or someone else might be able to follow up with some knowledge of these sorts of groups)

    A quick look online suggests that the ASBA [asbaonline.org] has some sort of discount on health insurance ... that might've been what I remember. As does NFIB [nfib.com] ... just type 'small business association' into your favorite search engine.
    • They usually team with some of their members who are Insurance Brokers to offer Group Health/Dental/Life.

      A nominal annual fee for membership, networking opportunities, and access to reasonably ( for some values of reasonable )... Such a deal!

  • In the UK, our Professional Contractors Group [pcg.org.uk] has just negotiated deals [pcg.org.uk] with a leading health insurer or two. I haven't seen the details yet, but it seems relevant to this discussion.

    Are there no similar organizations in your country doing this kind of thing?

  • First things first (Score:3)

    by OeLeWaPpErKe ( 412765 ) on Friday December 01, 2006 @07:53AM (#17063612) Homepage
    Congratulations on becoming a father !

  • Poor Americans, .. again (Score:4, Insightful)

    by Stigu ( 919228 ) on Friday December 01, 2006 @07:59AM (#17063658)
    Seriously, how dare you call yourself the "best country in the world" if you don't even have nationally implemented healthcare?

    Europe, glorious old lady that she is has long ago implemented the National healthcare to make sure that
    A; Everyone has access to proper healthcare.
    B; Everyone automatically pays into the healthcare fund so it can be maintained
    C; Good quality in healthcare is guaranteed by state checkups.


    In those days there were no "private" health insurance companies, but look what trusting in those has brought you? Deception, Fraud, and general run-around or obfuscation from most if not all of the private insurance companies.

    IMHO, healthcare is not, and has never been something companies should be in charge of. A companies purpose is to make money. The state however, if it's run by others then the idiots running the American state, should be more interested in keeping it's taxpayers ALIVE and healthy so they can work and pay taxes next year.
    • How is this a troll? Is see it more as a wake up call type of post. Surely there's not anyone who can actually argue that the American system is the best in the world? It's quite clear that there are third world countries with better systems, never mind the rest of the industrialised world.

      Bob
      • I know it's not all black and white but there is, as always, a middle ground here.

        In Finland for example, there is the normal European Union type of healthcare sate, but you also have private doctors, dentists, etc... I know from one of my Ex girlfriends father, that when he needed an immediate hearth surgery, it was arranged that very same day, by the public healthcare channels. They juggle the times to try and give those who need it most service first if there are waiting lists.

        When you are in a hur

    • Re:Poor Americans, .. again (Score:5, Interesting)

      by Anonymous Coward on Friday December 01, 2006 @10:15AM (#17064620)
      I agree with what you say, but the big difference here is that there are no waiting lists. I moved from UK to US, my family health issues are addressed immediately here. My friends and family in the UK get stuck on waiting lists with can be for months.

      Another difference is doctors here make a fortune, just like lawyers. Whereas those in the UK can work 80 hours a week for a middle income. Medical professional are also broken down into an infinite number of specialists here, there's little need to muck around with general practitioners, if you do, you'll get referred to a specialist pretty quick.

      There is also free medical for low income and freeloader types. Most places will not turn you away either. If you call up front, you'll be asked about insurance. Even when you receive huge bills, you can make small monthly payments to pay it off. Children without medical cover may be covered by the state, so if you have a young kid and a big bill, yet have no insurance, and if your income is low enough (which is less than something like $50-60k I've been told) the state will pick up the tab.

      It's not all doom and gloom like you think it is. Yes, there's a huge amount of profiteering, a bill will be for different values depending on payment, and insurance companies waste a huge resource avoiding payment, you really have to be on the ball even with cover. The real issues are for the long term sick, rather than fixing up a damaged body part.
      • Unfortunately, I posted above so I can't mod you up.

        I'm on a mailing list for people who have/had the kind of cancer I had. I've noticed a definite trend between the Canadian and US list members (there are only a couple from anywhere else). The Canadian members, with only one exception I've seen so far, have to wait about two to three months between diagnosis and starting chemo.

        In the US, the average wait is under a month. I personally went from the xray where they looked for pneumonia and instead found

  • Change is needed now (Score:5, Insightful)

    by Anonymous Coward on Friday December 01, 2006 @08:08AM (#17063710)
    First, you are about to find out just incredibly broken our health care system is. I doubt if you will get private insurance, as they are denying older applicants out of hand, and if you have ANY problem forget about it.

    Many states have an expensive health insurance pool that has high deductible insurance that will only take care of you in catastrophic conditions. If you go for the low deductible, expect to find very high premiums and equally high copays.

    With the high deductible plan you can start a health savings account (who has money to save these days?), but that may be your best option.

    Most important, keep your coverage with your wife current as long as you can as you may get your prexisting conditions covered without a waiting period.

    In my circumstance at least, I have found that health insurance companies have no reason to want to insure anyone that may be a liability down the road. I do not see a political solution to this, as congress is corrupt. The best they could do was pass a bill that made it hard for sick people who got burried by medical bills more difficult to declare bankruptcy. And another program that was essentially a handout to drug companies that foisted a compkicated hard to use drug plan onto seniors. That's all they have done. This last congress was the most do-nothing congress ever. It seems the only thing they had time for was to take bribes from abramoff and hit up underage pages for sex and try to cover up the trail later. The health care industry is not much better with their costs outpacing inflation 3 to 1 at least.

    I know neocons are not going to like what I'm about to say, and how important that it is fighting alquaida over in Iraq blah blah blah, but the fact is with what we have spent on this war to knock over a tin horn dictator I bet we could have paid for everybody's current medical expenses in the US, let alone making it affordable.

    If you're healthy and have job, you probably will not won't give what I have to say a second thought. But if your sick as I am and can't find coverage or a doctor, you know how bad it is. If your self employed doubly so. Even if you do have coverage, you have got to be noticing how your insurance premiums are getting more expensive and its covering less, your deductible is more, and prescriptions are through the roof.

    But the greatest crime of the Iraq war is that it has taken attention completely away from the health care crisis. I have talked to my politicians to no avail. Gratefully though, a challenger for state office DID talk about it and it got him elected.

    We had no business screwing around in Iraq (esp. with the WMD big lie) without taking care of our own at home first. It's that simple. If things aren't working for you, it's important to let your politicians and everyone around you know how you feel. Only this way will there be hope for change.

    BTW, make sure that the high deductible health savings account pays for 100% above a certain point. 80%, and you still could (likely)lose your shirt if you get sick.

    • Re: (Score:3, Interesting)

      by massysett ( 910130 )
      The funny thing is that the politicians (Republicans especially) will talk about how wonderful small business is and how it's the bedrock of the economy, yet healthcare costs are strangling small business. I'd think long and hard about even starting a small business, just because of the health care. Yet the politicians aren't even talking about the reforms we need.

  • Blues (Score:3, Informative)

    by tverbeek ( 457094 ) * on Friday December 01, 2006 @08:33AM (#17063846) Homepage
    I use an HMO program offered by my state's BlueCross BlueShield company. It's the same plan they sell to employers, but with me paying the full premium. It's not cheap (and for someone with a family it'd be even less so), but it's... affordable, and in the few years I've been using it, it's been a lot easier to budget the monthly premiums than it would have been to pay the medical bills I've had, and definitely made my recent visit to the ER less stressful, knowing I wouldn't have to pay for it.

    • Re:Blues (Score:5, Insightful)

      by baptiste ( 256004 ) <mike@baptis[ ]us ['te.' in gap]> on Friday December 01, 2006 @09:17AM (#17064140) Homepage Journal
      Except many people have varying concepts of affordable. I have kids so the BCBS plans for a family run in the range of $600 (barely covers anything) to a typical co-pay 100% plan you'd find at most corporations which runs almost $1100. That's over $13,000 a YEAR for health coverage. It's pretty scary when you're paying as much for health insurance as you are for your mortgage. Healthcare in this country is broken. We spend insane amounts on all the bean counters whose job is specifically to figure out how NOT to cover something and then blow hundreds of BILLIONS of dollars on a war fought over a lie and yet universal healthcare is some sort of evil that we can't afford. I know catastrophic illnesses can cost a lot of money. But over the course of, say, 20 years while your kids grow up, how many people are going to even come spent more than 25% of the $260,000 they pay in premiums. I also think it should be illegal for hospitals and doctors to 'negotiate' rates with insurance companies. Why does being self employed, poor, or a small business owner mean you have to pay 2-3 times more for services than someone who works for IBM? Everytime I see those EOBs where 50-75% of the cost is 'negotiated away' - we're all human - if they can survive charging $300 for a procedure, it should cost $300 for EVERYbody, not just people stuck in cubicles. And for those of you who will scream 'I don't want to pay for other people's healthcare in a universal system' you're naive. You already do. Besides that - you're supposed to be all 'support the small businesses' well, healthcare costs are a HUGE expense for small businesses. Imagine how many more would thrive if they didn't have such a disadvantage compared to medium or large size businesses? Good luck finding coverage you can afford. You're going to need it. Like the previous poster said - you almost HAVE to have the co-pay plan with young kids - the doctor visits are frequent. You're pretty much stuck.

      • Re: (Score:3, Insightful)

        by Ihlosi ( 895663 )
        But over the course of, say, 20 years while your kids grow up, how many people are going to even come spent more than 25% of the $260,000 they pay in premiums.

        Quite a few of them. All it takes is cancer, or a heart attack. Two of the top killers in industrialized nations.

      • Re: (Score:3, Insightful)

        by hal2814 ( 725639 )
        "I also think it should be illegal for hospitals and doctors to 'negotiate' rates with insurance companies."

        Why not? They'll negotiate with you. In fact if you can pay them promptly, they'll cut you a better deal than they'll cut any insurance company. Insurance companies have a nasty habit of holding onto payment well after it's due. If you can get cash in hand or even set up a payment plan with the hospital, they'll take it at a great loss (compared to their asking price). They won't advertise that b
        • This would be like making it illegal to negotiate on new car prices. Sure the car dealer has a high MSRP, but you're a fool to pay it. Our insurance system has it's problems, but hospitals and doctors being free to negotiate prices isn't one of them. Your analogy sucks. New car dealers negotiate with EVERYBODY, not just the poor and the self-employed. And there's that little detail about people being educated about the fact that they CAN haggle... not to mention that you're not likely to die if you don't g
      • The reason for negotiated prices, etc, is that hospitals have to cover the people who just don't pay. The people who would rather take bankruptcy than work out a payment plan for their $10,000 hospital stay for pneumonia or whatever. There are plenty of them, I know a couple in my own family.

        It's a vicious cycle, and I don't have any ideas for fixing it. People can't pay, so the hospitals have to charge others more to make up for it, or just stop treating people who don't have good insurance. The higher c

      • Re: (Score:3, Insightful)

        by mutterc ( 828335 )

        That's my take on socialized medicine: my tax rate could go up quite a bit before I'd end up paying as much more in taxes as my health insurance costs. Heck, it could probably double. I'd probably be actually financially better off with socialized medicine, and we wouldn't have these worries.

  • Couple of suggestions (Score:4, Insightful)

    by real gumby ( 11516 ) on Friday December 01, 2006 @08:58AM (#17063998)
    Buying insurance just on your own is expensive. There are various parameters you can fiddle to help (e.g. register kid and parents separately, though this means you don't share a deductible; set your deductible as high as possible -- here the highest I could get was $5000/yr, which really ends up being more like $10K), but it's really expensive -- we were paying about $300 a month and were in perfect health -- that was almost 4K + deductible per annum.

    (it's even worse for a small company under 25 employees!)

    If you're a member of the IEEE or any other "entrepreur" association you qualify for a group policy via them. That's usually a good deal. For example a quick search of "self-employed association" just showed as its first hit an association that offers health insurance. I have no connection and won't shill for them by including the URL.

    If you live in CA I hear Kaiser is quite good though I've never used 'em myself.

    Good luck. You'll find a lot of "well baby" visits will be needed in the first year or so. Well, at more than you need as an adult anyway. The insurance companies usually subsidise them because it's cheaper to catch something in the bud.

    And finally, in all seriousness, consider moving to my home country, Australia. There's a preference for computer programmers under 40, and it's a great place to be or raise a kid. (though I live in California right now myself...)

    Oh and have fun. One thing to be careful of / manage: I basically didn't work for the first couple of years after my kid was born and again when he was perhaps 4-6. That was really great. Try to find a way to balance the time with the family with making sure there's some regular income!

  • IMPORTANT (Score:5, Insightful)

    by SpartacusJones ( 848951 ) on Friday December 01, 2006 @09:10AM (#17064094)
    Before you drop your wife's insurance let me tell you what I am currently finding out the hard way. You will be hard pressed to find an insurance policy on a pregnant woman. Group policies can be more forgiving, but so far everyone I've talked to says it is a 'pre-existing condition' and they won't cover my 7-weeks pregnant wife. If you are going to get a policy, your wife can't deliver for 11 months from the date the policy becomes effective or it's not covered.
    I just got out of the Air Force and am now working as an independent contractor. Tricare does have a COBRA-type polkicy I can get but it's very expensive. I can't just get the coverage for my wife, I have to be on the policy, so I'm having to pay about $2200/3 months for it. At least it comes in 3 month chunks, so I won't have to carry it longer than I need it.
    If there weren't that program available to me, I don't know what I'd do. In Georgia where I live there is a Medicade program for pregnant women, but I make too much money to qualify for that. If you make more than $1600/week with a family of 4 (they count the unborn) you make too much. My wife had to have a c-section last time and I saw the bill Tricare got. For everything throughout the pregnancy they paid out over $60k.
    I have heard that if you can't get coverage and you talk to OB docs, they can usually work with you and sometimes you can end up paying less than if you had insurance. I have not looked in to that yet. Good luck!

    • Re: (Score:2)

      by jschrod ( 172610 )
      That's unbelievable.

      I knew that the US medical insurance system sucks, but I didn't know that it sucks so much. Good luck for your wife, that she delivers without any problems for her or the baby.

    • Can you explain how this situation would work out.

      A colleague of mine started work for us, got pregnant very early on and left after ten months to go on maternity leave. Difficult labour and eventually gave birth via C-section.

      This is in the UK so it's all on the NHS and paid for by the taxpayer, the company don't provide private health insurance.

      What would happen in the US - presumably the company would have some form of health insurance, but she wouldn't be covered so they'd just let her die? I'd really l

      • Re: (Score:2)

        by Ihlosi ( 895663 )
        but she wouldn't be covered so they'd just let her die?

        Oh no, that's not going to happen. Ending up neck-deep in debt is the likely outcome, with all its nasty side effects (sleeping under bridges and such).

    • Funny is some states preexisting conditions only count for things that were not covered via the previous insurers so as long as there is not a gap in coverage you can switch freely. I moved my wife from her insurance to independent insurance mid pregnancy without any issues or rate difference (I filled out the form each way online for the quotes). In your case it seems like pick up the cobra and get a new insurer.

  • Go for the high deductible (Score:4, Interesting)

    by bhmit1 ( 2270 ) on Friday December 01, 2006 @09:13AM (#17064116) Homepage
    I'd recommend a high deductible plan if you're self employed. You should already have money saved up to weather the rough times, so just add some more to cover the deductible. The amount you save is significant. The baby will most certainly have you going to the doctor a lot. I've used eHealthInsurance [ehealthinsurance.com] myself, and my only complaint is that the fine print is hard to find or not available until after you purchase a policy. But the policies they offer are from the major carriers.

    For the record, the place I got in trouble was picking the cheaper plan and then getting a physical. Burried back in the fine print was a clause that they don't cover anything preventative, but that wasn't obvious when I was ordering the plan or looking through the main section of the booklet. Had I clicked a link to the provider's comparison of all their plans, it would have jumped out like a sore thumb. Personally I think it borders on criminal when a company doesn't make it obvious where you risk owing a lot of money and what coverage is missing that many others would frequently include.

    And a final note, always get the price an uninsured person will be responsible for up front for everything! This is what you'll be stuck paying when the insurance company says they aren't responsible, and you should be able to afford it. My family's neighbor (a doctor), myself, and many others agree, the medical system in the US is broken. Insurance is complicated, costs are going up, and lawsuits are giving insane sums of money for just about anything. My biggest peeve is that you aren't told how much you owe until a month after the procedure is done. Admittedly this is a service and things may fluctuate when you find a problem, but every doctor uses charge codes and their office knows their fee for that code, and the insurance companies know what they have agreed for those codes. But no one will tell you those numbers until after you've had the service. Congress would do a lot for people by requiring every insurance provider to publish how much they cover and what the patent is responsible for on a standard list of charge codes, and make it available before signing up for that coverage.

  • IEEE (Score:4, Informative)

    by shaka999 ( 335100 ) on Friday December 01, 2006 @09:21AM (#17064170)
    Join the IEEE.

    They have some good group deals for insurance setup just for cases like yours. They also have group life and a few other things that might be of interest.

    Oh, and its a good organization to boot :).

  • How about.. (Score:4, Insightful)

    by Eivind ( 15695 ) <eivindorama@gmail.com> on Friday December 01, 2006 @09:22AM (#17064180) Homepage
    How about moving to a civilized country ?

    You know, one of those where it's recognized that decent healthcare for everyone is a good thing.

    It's quite silly, the way you do it in USA. It prevents people from acting rationally, to the detriment of all. (it's the same in *parts* of Europe, you guys aren't alone about it.)

    For example, a friend of mine (living in the USA) is currently at home (watching his baby) while the mother works. He works a little evenings and earns a little extra for the family, but little enough that he was still health-insured trough his wife.

    Then he got offered a larger position. He had to turn it down. It'd have put him above the limit where he'd need his own health-insurance, so in the end he'd have ended up working *more* and getting *less*, which is nonsense.

    Everyone is a loser in this scenario:

    • The family doesn't get the extra income.
    • The employer doesn't get the extra work done. (atleast not by the person that was his first choice)
    • The insurance-industry covers both today, paid for by his wifes employer, the two of them wouldn't actually be *more* sick if he worked more.
    • The state (and thus indirectly all projects that benefit from tax-money) don't get the extra tax-money thay he'd have paid if he worked and earned more.

    Stupid. Very stupid.

    It should pay to work. Putting someone in a situation where they get *less* for working *more* just serves as an insurance that these people won't, infact, work more.

    There's similar mechanisms in welfare-programs too, where you earn $100 more and get $150 less from welfare. The effects are similar. (it'd have been different if you'd earned $100 more and as a consequence gotten $50 less from welfare, that'd have been fine)

    • You know, one of those where it's recognized that decent healthcare for everyone is a good thing.

      I know why you think that, but it's not a "good thing", for a simple reason: What if you don't like you're health care? I can go to another insurer. I can go to another doctor. I can do pretty much any damn thing I want. I never have to wait for anything. You're at the mercy of what your government provides, including the infamous "waiting list".

      No thanks. I'd like my complex-and-expensive knee surgery sch

      • Re: (Score:3, Informative)

        by dunkelfalke ( 91624 )
        if you cannot afford the complex-and-expensive knee surgery one day you'll lose your pride quite fast and cry for a nanny state.

        besides, in europe you can also go to another insurer if you don't like your healthcare. but all insurers provide basic services by law.

      • Re:How about.. (Score:4, Informative)

        by Ihlosi ( 895663 ) on Friday December 01, 2006 @10:31AM (#17064810)
        I know why you think that, but it's not a "good thing", for a simple reason: What if you don't like you're health care? I can go to another insurer.

        If you see everything as black and white ...

        I can go to another insurer too. A different public one, or a private one. I can go without insurance if I really wanted to.

        I can go to another doctor.

        Me too ! I can go to any doctor in the whole country. And some of the neighboring countries, too.

        State-run medical care doesn't exclude any of the things you mentioned. It all depends on the details of the implementation. You're at the mercy of what your government provides, including the infamous "waiting list".

        You're just replacing one waiting list with another one (ordered by who'll pay the most).

  • Look into using an 'umbrella' company (Score:3, Informative)

    by Jah-Wren Ryel ( 80510 ) on Friday December 01, 2006 @09:26AM (#17064212)
    Also known as "employer of record" - they exist for independents who need "big corp" sorts of benefits like access to health insurance. Here is one that I haved used in the past - MyBizOffice. [mybizoffice.com] Despite the stupid, formerly-trendy name, they are one of the largest out there and do a pretty good job of things.
  • ..this one (congratulations by the way :) being a daddy is awesome), your choices will be limited because maternity coverage is sparse and expensive. I recommend that you contact *several* health insurance agents (the ones who shop around for insurance for you like they would for a company) and ask them all to look for the plan you need. This at least will save you from having to figure out which plans are out there, which ones cost what amounts, which ones cover these features, yadda ^ 3. I was doing th

  • What about COBRA? (Score:5, Informative)

    by Bored George ( 979482 ) on Friday December 01, 2006 @09:46AM (#17064346) Homepage
    Even if your wife leaves her job, she (and the family, if you have a family policy) can stay on her former employer's health insurance for 18 months under COBRA [dol.gov]. But they can charge you the actual cost of the policy plus two percent. (Meaning if she currently plays 80% of the cost of the policy through deductions and the company pays the other 20% percent, after you go on COBRA you'll pay the 80% + 20% + up to 2%. The HR department of her company can tell you the COBRA rates.)

    After the 18 months of COBRA runs out, the insurance company is required to offer you a non-group policy that is not medically underwritten. I think they usually call this a HIPAA policy. This will probably be more expensive than the policy you get through COBRA, but you can't be denied for pre-existing conditions.

    It's been a while since I've read the DOL publication on COBRA, so follow the link above to verify that none of the details have changed.

  • HDHP + HSA (and don't spend the HSA money) (Score:4, Informative)

    by G4from128k ( 686170 ) on Friday December 01, 2006 @09:54AM (#17064436)
    HDHP + HSA is the way to go if you are at all heathy and fiscally prudent. Low deductible insurance is a money loser. With a low deductible, you are all but guaranteed to pay more in premiums each year than you would by saving the money and paying from savings. The tax-deferred/tax-free nature of the HSA makes this even more true.

    Also, the HSA regs give you tax advantaged savings based on the money you put into the HSA (not the money you take out of it). Check with your accountant, but I believe that nothing in the IRS regs says you must pay for all healthcare expenses with HSA money. Yes, you can't use HSA money for anything but healthcare (unless you are over 65 or disabled), but that doesn't imply that you can't use non-HSA money for healthcare costs. An HSA is a great way to build more tax-deferred savings if you've hit the limits on other tax-deferred savings programs.

  • US Health Care Costs (Score:3, Interesting)

    by rlp ( 11898 ) on Friday December 01, 2006 @10:02AM (#17064510)
    A while back the WSJ published an article on where US health care costs go. Around a third of the costs went to two places - lawyers and terminal care. Medical procedures don't always have a happy ending. All too often - when they don't have a good outcome, Americans tend to sue. The last stages of life in America are very expensive. Most Americans die in a hospital attached to tubes and instruments. And this doesn't count costs like defensive medicine (too many tests to avoid potential litigation). So more use of hospice services and real tort reform would go a long way to lowering costs of health care. Of course this would negatively impact profits at commercial hospitals and income of trial lawyers. Don't expect action from either political party any time soon.
  • Have your wife get a part time job with the post office or some other government job where she would get government benefits which usually come out ahead of what the private sector offers.

  • Speaking From (Too Much) Personal Experience... (Score:5, Informative)

    by stan_freedom ( 454935 ) on Friday December 01, 2006 @10:13AM (#17064594) Homepage
    Unfortunately, I have way too much experience with health insurance, so here's my suggestions.

    1. Extend your wife's plan with COBRA even after she quits at least until your baby is born. Do this, even if that means traveling further because your closest hospital is no longer in network. My first child required an emergency C-section and a few days in the neonatal ICU. He was almost 11 pounds at birth and there was no way he was coming out through the in door, so to speak. The bill was pretty amazing, but I didn't have to pay much out-of-pocket. So, if there are additional expenses related to your child's birth, at least you won't be completely screwed. On a side note, my son ended up with cerebral palsy, possibly due to decisions made by our doctor and his team. Learn up front about what can go wrong, and don't assume the experts are paying close attention to your wife/child.

    2. Never go without health insurance and life insurance. I was 33 years old and my wife was pregnant with our third child when I found out I had testicular cancer. I caught it before the cancer had spread, but I still required one minor and one major operation, all kinds of diagnostics, and years of follow-up. My bills, way back in 1994, were well over $100K. My insurance at the time covered almost all expenses. Because I had life insurance, I had one less thing to worry about. Without life insurance, I probably would have died simply from stress.

    3. If you have pre-existing conditions, you really need some type of group plan. Individual insurance plans are out of the question if you have any kind of serious pre-existing condition (cerebral palsy, testicular cancer, etc.). I know, because I tried this route. I pay around $10K per year for medical/dental at my current company. I thought that was a ripoff until I tried to get insurance on my own. Your only reasonable way to get health insurance is to be in some kind of group plan where your risks can be spread across a large pool of individuals. Even then you may have problems if you have any coverage gaps or you aren't going into a large enough group plan. If you have no pre-existing conditions and are healthy, the medical savings plan along with a high deductable plan is a cost-effective approach.

    4. Without health insurance, you pay much higher rates for the same procedures/care. I recently had a 4-day stay in the hospital (as a result of the cancer surgery 10 years earlier). The unadjusted bill was 3 times the amount of the adjusted bill. Without insurance, you get the unadjusted bill and no expert on your side to help negotiate the bill down.

    Hopefully your luck will be better than mine when it comes to health. However, I can say that insurance has saved me from financial ruin on more than one occasion. More important, insurance allowed me to make career and life decisions (like having more than one child) that I may not have made if I was paying out the ass for the rest of my life due to one bad medical experience.

    I wish I had an answer for our country's current medical insurance problem. I don't think a government-based single-provider solution is best, but I think government may need to help fund large group plans that are affordable for the tens of millions of americans that want insurance but can't afford it. The uninsured are driving up costs for the rest of us by waiting too long to get care, and then entering the system directly through hospital emergency rooms. I'm encouraged by the pay-as-you-go clinics that are popping up at Wal-Marts and elsewhere for non-emergency care. It costs a lot less to pay $25 at a clinic to have your kid checked out than to wait until your kid is seriously ill and then take him/her to the emergency room.

    Best of luck with your new family.

    • Re: (Score:2)

      by Ihlosi ( 895663 )
      Your only reasonable way to get health insurance is to be in some kind of group plan where your risks can be spread across a large pool of individuals.

      Actually, isn't this the point of _any_ type of insurance ? The cherry-picking in individual plans leads the whole principle ad absurdum, but I guess it's the best for the people that an insurance company really cares for (its shareholders).

  • Same boat, here's my solution (Score:3, Interesting)

    by mattnuzum ( 839319 ) on Friday December 01, 2006 @01:27PM (#17068188) Homepage
    I'm in the same boat. Been there for years, and it's frustrating.

    Ideal: put $10,000 - $15,000 in the bank for emergency use and go with a super-high deductible ppo. Your rates will be low, maybe about $150 /month. This will save you about $300 per month which you can use for medical expenses when you need it. If your family is reasonably healthy, you shouldn't have $300 /mo that often (but it will happen sometimes - so be prepared). In the end you come out better because you get to pocket the money you budget for medical expenses if you don't use it.

    Next best thing: I went with Farm Bureau (www.fb.com) - I'm not a farmer, but they help self-employed people get insurance. The rates were the most reasonable I could find, and there was a person I could go talk to. They also do retirement planning and other types of insurance - most importantly, they have good rates on long-term-disability, which you should definitely have if you're self employed and you care about the long-term needs of your family. They also have life insurance at fair rates, but I got a better rate through my home/car insurance company (allstate).

  • "What he said" mostly, but.... (Score:4, Insightful)

    by mschuyler ( 197441 ) on Friday December 01, 2006 @02:05PM (#17068918) Homepage Journal
    Lots of good comments and suggestions. I notice costs vary widely around the country. Just to aid comparison.

    1. I pay $135 month for $5K deductible at age 57. Every five year increment goes up a few bucks. Every year the whole grid goes up a few bucks. "Full" insurance with a small deductible and small co-pays would be about $550/month. Rationale: At $550/month that's, umm $6600/year. $135 is $1620. If I get 'really' sick, I break even. In any case it would appear this is a lot less expensive than some of you are paying for a similar $5K deductible.

    2. Several people seem to think voting Democratic or moving to Canada/Britain/etc. will solve the problem. Does anyone really think nationalized health care will give us a BETTER system? Do you REALLY want Hiliary calling the shots here? Just look at our military or the VA system. The VA, if you can get on it, is totally free. I won't say it's a bad system, but let me say this. My father was on it. I thought it was a good deal at the time. But had he been on medicare plus a supplemental he could have used local doctors instead of the long ride to a VA facility--and he just might still be alive today. I dunno, it's hard to figure it out in hindsight, but I wish we had the option of doing his health care over again the other way. He DID get a free slot in the wall at the Veteran's Cemetery, though.

    3. The worst problem, imho, is that we've messed up by insisting health care be part of employment. Now people think employer-paid insurance is a "right" and will strike if the employer wants to reduce some costs with a co-pay. Insurance companies have lept on this, too because by and large if you are working, you are healthy. Really sick people can't hold a job. It's in insurance companies' best interests to further such a system. People keep working in terrible jobs just to keep insurance. I have a buddy who could otherwise retire. I say to him, "Why not?" and he always says, "Insurance." Now that sucks.

    4. Health care is not in the Constitution. On the one hand we demand government be responsible and take care of every individual every time he has a cold and winds up going to the emergency room for it, stupidly. We are so risk averse that we blame anyone we can for anything that happens to us. Government is a prime target, but so is anyone, including McDodalds with hot coffee. Then we turn around and say, well, government should not invade my privacy (which isn't exactly in the Constiution either.) The thing is, we have INVITED government into our lives on a very personal basis, then wonder why it is there. You can't expect government to NOT be in your life if you won't take responsibility for your own life in the first place.

    I would prefer government NOT be in my life, or there as little as possible. I will trade that for taking responsibility for my own health and my own life. Just get out and leave me alone. We'll all be better for it.

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